Pentagon Report Criticizes Troops' Mental-Health Care

U.S. troops returning from combat in Iraq and Afghanistan suffer "daunting and growing" psychological problems -- with nearly 40 percent of soldiers, a third of Marines and half of the National Guard members reporting symptoms -- but the military's cadre of mental-health workers is "woefully inadequate" to meet their needs, a Pentagon task force reported yesterday.

The congressionally mandated task force called for urgent and sweeping changes to a peacetime military mental health system strained by today's wars, finding that hundreds of thousands of the more than 1 million U.S. troops who have served at least one war-zone tour in Iraq or Afghanistan are showing signs of post-traumatic stress disorder (PTSD), depression, anxiety or other potentially disabling mental disorders.

"Not since Vietnam have we seen this level of combat," said Vice Adm. Donald Arthur, co-chairman of the Department of Defense Mental Health Task Force. "With this increase in . . . psychological need, we now find that we have not enough providers in our system," he said at a Pentagon news conference yesterday unveiling the report. "Clearly, we have a deficit in our availability of mental-health providers."

The ongoing "surge" of more than 30,000 additional U.S. troops in Iraq and Afghanistan will exacerbate this gap, as will the rapid growth in the number of soldiers, Marines and other troops -- now about half a million -- who have served more than one combat tour, heightening the risk of mental illnesses, the report said.

As in the aftermath of Vietnam, the costs of untreated mental illness will rise dramatically over time, the report warned. "Our nation learned this lesson, at a tragic cost," it said. "The time for action is now."

Defense Secretary Robert M. Gates is required by law to develop a plan of action within six months on the 95 recommendations included in the 64-page report.

The task force, composed of seven military and seven civilian professionals with expertise in military mental health, was formed in May 2006. It based its report on visits to 38 U.S. military care facilities in the United States, Europe and Asia; interviews with care providers, military personnel and their families and commanders; as well as expert testimony and research.

The task force found that 38 percent of soldiers, 31 percent of Marines, 49 percent of Army National Guard members and 43 percent of Marine reservists reported symptoms of PTSD, anxiety, depression or other problems, according to military surveys completed this year by service members 90 and 120 days after returning from deployments.

Two "signature injuries" from Iraq and Afghanistan are PTSD and traumatic brain injury, it said. Symptoms include nightmares and other sleep problems, trouble concentrating, anger, recklessness, and self-medication with drugs and alcohol.

The task force identified several barriers to care, including the stigma associated with seeking help, poor access to providers and facilities, and disruptions in care as service members move locations.

"Stigma in the military remains pervasive and often prevents service members from seeking needed care," the report said, citing anonymous surveys that show most members with symptoms of mental health problems do not seek help.

Some soldiers underreport problems because they want to stay with their units, and military officials note that many soldiers undergoing treatment for stress or other mental problems are allowed to deploy again after a screening to determine the intensity of their symptoms or depending on what medications they are taking. Those on lithium, for example, should not deploy while those on another class of medications similar to Prozac may be able to, said Army Col. Elspeth Cameron Ritchie, who assisted the task force.

"If you have a post-traumatic stress reaction, it's not your fault," Arthur said. "It's up to leadership to say to folks that post-traumatic stress reactions are an absolutely normal part of combat operations."

Proposals by the task force to reduce stigma include embedding health-care providers with units and offering treatment at primary medical care facilities, where service members can seek psychological help without singling themselves out. An additional recommendation is for the military to begin training troops to become more psychologically resilient, in part by conditioning them mentally, much as they conduct their physical training.

"We can use virtual-reality therapy, typing smells in to create a virtual environment," that resembles a battlefield, said Col. Jonathan H. Jaffin, commander of Army medical research.

National Guard and reserve members -- who often live far from military bases and return from deployments to rural communities -- face "particularly constrained" access to clinical care as well as to the military chaplains and family support networks that active-duty personnel can tap, the report said.

"The current complement of mental health professionals is woefully inadequate" to prevent and treat members of the military and their families, the report said. But it called the process for recruiting additional trained personnel -- both civilian and military -- "time consuming and cumbersome," stating for example that the number who could be recruited over the next six months would be "well below" the number required to meet the needs.

The shortage is deepening as active-duty mental-health professionals, also stressed by repeated deployments and other frustrations, are leaving the military in growing numbers, the report said. The Air Force has lost 20 percent of mental health workers from 2003 to 2007, while the Navy lost 15 percent between 2003 and 2006, and the Army lost 8 percent from 2003 to 2005.

Financial resources for mental health treatment in the military are also lacking, the report found. Congress provided a boost of $600 million for PTSD and traumatic brain injury in the 2007 supplemental war funding, but more will be needed, S. Ward Casscells, assistant secretary of defense for health affairs, said at the news conference.